By NEIL HARTNELL
Tribune Business Editor
The Medical Association of the Bahamas (MAB) president yesterday said this nation’s best doctors are not signing up for the National Health Insurance (NHI) scheme, with the Government’s efforts to woo and pressure them seemingly failing.
Dr Sy Pierre told Tribune Business that while he had no ‘hard’ numbers, his conversations with high-level physicians and MAB members indicated that few, if any, were registering to provide services for the $100 million primary care phase.
“I’ve spoken to the consultant-level physicians, those who have specialist licenses,” Dr Pierre said, describing these as the likes of paediatricians, obstetricians, gynaecologists, and family medicine specialists.
“I don’t have any official numbers, but my feeling is that the top-level consultants are not signing up. The guys who are signing up are the GPs (general practitioners).
“They’re the ones who are out in the community, but don’t have specialist training. They are general practitioners. They are a dying breed, but there are a number of them. These guys are the ones signing up,” the MAB president added.
“The lower tier physicians will take this; it will be an economic boon for them. But the primary care specialists, the experts, they’re telling me they’re not signing up because they can’t run a practice on what the NHI primary care phase is paying.”
The Christie administration’s NHI Secretariat this week appears to have intensified its efforts to both encourage, and pressure, private doctors to sign up for the primary care phase prior to the March 31 deadline.
A full-page newspaper advertisement, taken out in both dailies, shows a doctor sitting with a patient, under the headline,’Have you had the talk’.
It implies that doctors will lose out, and could suffer a reduction in patient volumes, if they do not sign up for NHI, citing a ‘poll’ that found 64 per cent of Bahamians surveyed would switch physician if they were not registered for the scheme.
No statistical or scientific data was available to back up this finding, with the advertisement effectively urging the Bahamian public to pressure private doctors to sign-up for NHI.
It also called on Bahamian doctors to “be part of history” and register, and added: “Have your patients talked to you about NHI?”
It appears, though, that the Government’s tactics to encourage private doctor sign-up are not working. Tribune Business last night spoke to two senior private doctors who, speaking on condition of anonymity, said not one patient had requested them to sign on for NHI.
“I’ve had no pressure from any patient,” one told Tribune Business. “They’re saying: ‘We don’t want you to sign up; don’t be part of this madness’. I’ve certainly not seen any negativity from my patient population.
“My patient population are very concerned that NHI is just another scheme for the Government to misuse public funds.”
The other doctor added: “I talk to my patients all the time. They think it’s a pile of nonsense, can’t be sustained and feel that they’re being forced to sign-up through the NIB smart card.”
Adamant that neither of them would sign on to provide services under the NHI scheme as currently proposed, they added that the Secretariat’s campaign was “a sign of desperation”, and that there was “no question” that not enough physicians were signing up.
“They’re pulling at straws,” one of the doctors said. “They’re trying to get the junior doctors to sign up. None of the obstetricians and gynaecologists, none of the paediatricians, and none of the family doctors have signed up.
“I’m not surprised at the tack they’re [the Secretariat] taking, and turning the patients on. They won’t be able to get the quality of care; the quality of care will be compromised.”
They added that the NHI Secretariat and the Government were “ignoring the time and resources I’ve put in over the years to get my practice to where it needs to be, and what it costs to operate a proper medical practice in this country”.
Tribune Business was told that each specialist group of doctors is coming together, with none signing on for NHI. This newspaper understands that the prevailing mood among specialist physicians is to ‘wait it out’ and see what happens with the general election outcome, hoping for a change of government.
One doctor spoken to by Tribune Business last night questioned whether those doctors signing up to provide NHI primary care services had the necessary capacity at their facilities to deal with the likely patient volume.
They also questioned whether they would have the links to radiologists and x-ray imagers, laboratories, pharmacists and care managers, that are required for holistic care.
Dr Pierre agreed that “the quality of care is always a question”, but argued that these issues would always arise with a system of “socialised medicine” such as ObamaCare or NHI.
With the NHI scheme likely to increase patient volumes and populations, Dr Pierre said questions would arise over how much time doctors will be able to spend with individuals. Waiting times and queues for treatment, he added, were another concern.
With some 200,000 Bahamians said to lack private health insurance, the MAB chief reiterated that NHI’s $100 million primary care budget equated to $500 per person, per year.
This equates to less than $50 per person, per month, and Dr Pierre said: “You cannot get a good health insurance plan for a family for $300-$500 per month.”
He added that the main way to improve healthcare was through an expanding Bahamian economy, where jobs and rising incomes enabled people to better afford health insurance.
Without enough private doctors registering to provide services, a major goal of NHI - to take the pressure off the public healthcare system by sending patients to them - could be in jeopardy.